Effects of treatment and the metabolic response to injury on drug clearance: a prospective study with piperacillin.
The disposition of piperacillin was prospectively evaluated in 11 critically ill surgical patients who had no evidence of pre-existing renal and hepatic disease. Interpatient variations were demonstrated in the drug's half-life, distribution volume, and clearance, with values of 1.50 +/- 2.05 (SD) h, 25.0 +/- 17.2 L, and 23.8 +/- 17.2 L/h, respectively. Variations in piperacillin disposition were best explained by serum concentrations of albumin, total protein, and bilirubin, and the amount of urea nitrogen excreted daily in urine. Age and renal function were moderately associated with piperacillin elimination rate and clearance. Altered piperacillin disposition thus appeared to occur as secondary to changes in the patients' physiologic and metabolic state caused by injury-related stress and fluid/colloid therapy. These alterations may necessitate dosage modifications to achieve optimal patient response when treating patients with piperacillin as well as with other similar drugs eliminated via renal and nonrenal routes.
Shikuma
L R
LR
College of Pharmacy, University of Minnesota at St. Paul-Ramsey Medical Center 55101.
Ackerman
B H
BH
Weaver
R H
RH
Solem
L D
LD
Strate
R G
RG
Cerra
F B
FB
Zaske
D E
DE
D000328:Adult; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006207:Half-Life; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D008875:Middle Aged; D010878:Piperacillin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000378:metabolism* / Q000628:therapy
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D010878:Piperacillin